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05/20/2015 Prior Authorization MERCY MARICOPA INTEGRATED CARE - TXIX/XXI SMI MEDICAID DPP-4 Inhibitors This fax machine is located in a secure location as required by HIPAA regulations. Is this request for or XR Circle Yes or No Y N If no then skip to question 3. Complete/review information sign and date. Fax signed forms to Mercy Maricopa Integrated Care - TXIX/XXI SMI at 1-855-247-3677. Please contact Mercy Maricopa Integrated Care - TXIX/XXI SMI at 1-800-564-5465 with questions regarding...
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When conditions are met refers to a situation where certain criteria or requirements have been satisfied.
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The individual or entity responsible for meeting the conditions is required to file when conditions are met.
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The information that must be reported on when conditions are met includes details on how the conditions were met, any supporting documentation, and any relevant dates or deadlines.
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